血栓弹力图判断创伤性凝血病患者预后的临床价值  

Prognostic value of thromboelastography for trauma-induced coagulopathy

作　　者：曾庆波[1] 宋景春[1] 钟林翠 邓星平[1] 胡艳晶 宋晓敏[1] 李兆芳 ZENG Qing-bo;SONG Jing-chun;ZHONG Lin-cui;DENG Xing-ping;HU Yan-jing;SONG Xiao-min;LI Zhao-fang(Department of Intensive Care Unit,the 94th Hospital of Chinese PLA,Nanchang 330002,Jiangxi,China)

机构地区：[1]解放军第九四医院重症医学科,南昌医学硕士330002

出　　处：《医学研究生学报》2018年第12期1285-1288,共4页Journal of Medical Postgraduates

基　　金：江西省科技支撑计划项目(2014BBG70057);江西省卫生计生委科技计划(20163016)

摘　　要：目的创伤时凝血功能紊乱是导致患者死亡的独立危险因素。文中应用血栓弹力图(TEG)的相关指标判断创伤性凝血病患者的预后,并对其临床价值进行评价。方法回顾性分析2015年9月至2018年7月解放军第九四医院重症医学科收治的124例创伤性凝血病患者,收集患者入重症医学科时的临床资料、入院2 h内的血小板计数(PLT)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)以及TEG结果。根据患者伤后90 d的预后分为生存组(n=108)和死亡组(n=16),比较两组间TEG相关指标。通过logistic回归分析和ROC曲线筛选最佳预后判断指标,并根据指标界值分组,比较组间的血小板计数和病死率。结果与生存组的血块形成时间(K)[3.2(2.2～4.8) min]相比,死亡组K[5.2(5.0～9.8) min]显著延长(P<0.05);与生存组相比,死亡组α角[(47.01±16.27) vs (39.24±16.29)]、血块最大强度(MA)[(49.99±12.39) mm vs (37.88±11.89) mm]和凝血综合指数(CI)[-3.1(-5.9～-1.15) vs-6.5(-6.9～-5.5)]均显著降低,差异有统计学意义(P<0.05)。Logistic回归分析显示MA值与创伤患者的预后密切相关。ROC曲线分析显示,MA的曲线下面积为0.789,其界值为45.65 mm,敏感度、特异性、阳性预测值和阴性预测值分别为72.2%、87.5%、66.7%和97.5%。MA<45.65 mm组的PLT计数[86(46～114)×10~9/L]明显低于MA>45.65 mm组[116(84～171)×10~9/L],病死率则明显高于MA>45.65 mm组(31.8%vs 1.2%),差异均有统计学意义(P<0.05)。结论 TEG指标中,MA能够判断创伤性凝血病的预后。MA<45.65mm提示创伤性凝血病患者已经出现血小板早期功能障碍,并预示预后不良。Objective Coagulation disorder is an independent risk factor of death in trauma patients.This study aimed to investigate the prognostic value of thromboelastography(TEG)for patients with trauma-induced coagulopathy. Methods This retrospective study included 124 cases of trauma-induced coagulopathy treated in our Department of Critical Care Medicine from September 2015 to July 2018.We collected the clinical data and laboratory results of the patients within 2 hours after admission,divided the patients into a survival group(n=108)and death group(n=16)according to their 90-day prognosis after trauma,and compared the TEG parameters between the two groups.Using logistic regression analysis and ROC curves,we identified the optimal prognostic factors and compared the platelet(PLT)count and mortality rate among those with different cut-off values. Results In comparison with the survival group,the death group showed a significant increase in the clot formation time(CFT)(3.2[2.2-4.8]vs 5.2[5.0-9.8]min,P<0.05),but decreases in theα-angle(47.01±16.27 vs 39.24±16.29,P<0.05),maximum amplitude(MA/maximal clot strength)([49.99±12.39]vs[37.88±11.89]mm,P<0.05),and coagulation index(CI)(-3.1[-5.9 to-1.15]vs-6.5[-6.9 to-5.5],P<0.05).Logistic regression analysis revealed a significant correlation between MA and the survival of the patients.In the patients with the area under the ROC curve of MA=0.789 and its cut-off value=45.65 mm,the sensitivity,specificity,and positive and negative rates of prediction were 72.2%,87.5%,66.7%and 97.5%,respectively.The PLT count was significantly lower in those with MA<45.65 mm than in those with MA>45.65 mm(86[46-114]vs 116[84-171]×10 9/L,P<0.05),and mortality was remarkably higher in the former than in the latter group(31.8%vs 1.2%,P<0.05). Conclusion Among the TEG parameters,MA/maximal clot strength is a valuable indicator for the prognosis of trauma-induced coagulopathy,and MA<45.65 mm indicates early PLT dysfunction and poor prognosis.

关 键 词：创伤 凝血病 血栓弹力图 预后 血块最大强度 

分 类 号：R446[医药卫生—诊断学]